NCG020695 DMR SW

V
II ANNUAL SUMMARY DMR - STORMWATER
SEND TO CENTRAL OFFICE*
STORMWA TER DISCHARGE OUTFALLS (SDO)
111
JAN 21 W5
GENERAL PERMIT NO. NCG020000 CENTRAL FILES
*Report ALL STORMWA TER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH l of each year. 15VVR SE N
CERTIFICATE OF COVERAGE NO. NCG020695 SAMPLE COLLECTION YEAR: 2014
FACILITY NAME: Black Ankle Quarry COUNTY: Montgomery
PERSON COLLECTING SAMPLES: N/A PHONE NO. 336-584-8875
CERTIFIED LABORATORY: PACE ANALYTICAL Lab #12 ADD TO LISTERVE? YES❑ NOP EMAIL:
Part A: Stormwater Monitoring Requirements
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly
Monitoring?
(/n)
# of Months in Total Flow
Tier 2 (MG)
Sampling2
Total Suspended Total Event
Solids Turbidity4 Settleable Rainfall Duration
(mg/1) (NTU) Solids (mUl)
(in)
-
-
-
- -
1003'4 See Footnote 3,4 0.1 3
No SW Outfalls Exist
1/2014-12/2014
No SW Outfalls Exist
1/2014-12/2014
It "NO FLOW" or "NO DISCHARGE," enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
2Per NCG02: Tier 2 Monthly Sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 I a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Teir I or Tier 2 responses in the General Permit.
4TSS benchmark values are 100 mg/I except in ORW, HWQ, trout, and PNA waters where they are 50 mg/I.
5The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservois designated
as trout waters; 25 NTU for all lakes and reservois, and all salt water; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014
Last Revised 01-21-11
Page 1 of 2

Part A: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
Date Sample
Outfall Collected
No. (mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in
Tier 2
Sampling2
New Motor Total Flow TPH using method Total Suspended pH Total Event
Oil Usage (MG) 1664A SGT -HEM Solids (Standard Rainfall Duration
(gal/month) (mg/1) (mg/1) Units) (in)
- - 153 1003 6-93
No Outfalls Exist 1/2014-12/2014
No Outfalls Exist 1/2014-12/2014
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW" "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOUMUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION REPOR TED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information sumbitted. Based on my inquiry of the person or persons who manage the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisionment for knowing
violatio
1/2/2015
(Sig re of P mittee) (Date)
Permit Date: I/1/ 010-12/31/2014 Last Revised 0 1 -21 -11